Provider Demographics
NPI:1366463812
Name:HAYASHI, ROGER M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:M
Last Name:HAYASHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 SAMARITAN CT STE E
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4002
Mailing Address - Country:US
Mailing Address - Phone:408-358-8272
Mailing Address - Fax:408-356-7779
Practice Address - Street 1:2512 SAMARITAN CT STE E
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4002
Practice Address - Country:US
Practice Address - Phone:408-358-8272
Practice Address - Fax:408-356-7779
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG329022086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
770000663OtherRAILROAD MEDICARE PIN
CA00G329020Medicaid
CA00G329020Medicaid
770000663OtherRAILROAD MEDICARE PIN